Approach to Chronic Kidney Disease Flashcards
Chronic kidney disease (CKD) is an abnormality of kidney __ or __, present for > __months.
Chronic kidney disease (CKD) is an abnormality of kidney structure or function, present for > 3 months.
GFR criteria for CKD
GFR <60 ml/min/1.73m^2
GFR is used to quantify kidney function because of 3 reasons
- it is a marker of excretory function
- it is correlated with widespread damage to the kidneys
- it is associated with progressive complications of kideny disease
Glomerular filtration rate (GFR) definition: Rate that fluid is filtered across the __ ___ __ into the __ __
Rate that fluid is filtered across the
glomerular basement membrane into the renal tubules
there are many equations to solve GFR, but all need to be relative to ___ ____ ___ due to the difference in kidney size
all must account to body surface area
the gold standard of measuring GFR is measuring ___ clearance, but it is impracticeal because:
instead, we estimate GFR using ____. We must take into acount the age, ___ and ___ of the patient.
the gold standard of measuring GFR is measuring INULIN clearance, but it is impracticeal because: YOU NEED A CONSTANT INULIN INFUSION, MULTIPLE BLOOD AND URINE SAMPLES, AND REGRESSION ANALYSIS
instead, we estimate GFR using CREATININE. We must take into acount the age, SEX and ETHNICITY of the patient.
GFR equation more accurate in younger patients and those with higher BMI and lower levels of kidney fucntion
the CKD-EPI
factors that increase plasma creatinine (5) and lead you to underestimate creatinine levels /gfr
- high muscle mass
- ingestion of cooked meat
- creatine supplements
- race, ethnicity– african americans
- reduction of gut creatininases.
factors tha reduce creatinine secretion
medicaations like trimethorpim, cimetiidine, fenofibrate.
factors that reduce plasma creatinine
small muscle mass
amputation
muscle wasting disease
dialysis
- these will all tend that you overestimate GFR
the rock:
this athlete with no limbs:
Usually, the definition of CKD is having a GFR <60 ml/min/1.73m2. what if the CFR is more than that?
CKD may present as >60 ml/min AND evidence of kidney damage either through abnormal urinalysis of imaging
things in urine sediment that might indicate kidney structure abnormalities
- proteinuria. albuminuria >30mg/day or ACR >3. Can also be non-albuminuria
- dysmorphic hematuria or RBC casts
- WBC casts
- granular casts or renal tubular epithelial cells
urine electrolyte issues that might indicate CKD
urine electrolyte wasting
t/f: a lower gfr is associated with an increased risk of death, CVD mortality, and hospitalization.
true
CKD is classified by the CGA staging. outline the 3 standings of CGA
- cause
- GFR
- Albumin.
65y M with kidney biopsy that indicated ANCA-associated vasculitis with a GFR of 27 ml/min/1.73m2 and ACR of 25 mg/mmol and biopsy proven ANCA- associated vasculitis.
What is the stage pf CKD?
• = Stage G4 A2 CKD secondary to ANCA associated vasculitis
Note
history questions to evaluate CKD
determine the underlying cause
physical exam method to use to evaluate CKD
lab investigations when evaluating CKD
Please identify the stage of CKD for the individuals listed below.
